If you’re pregnant or planning to become pregnant amid the current pandemic, chances are that some of the material you’ll come across in your online research dating prior to 2020 may not hold true for at least the time being. And it will be hard to determine what is and isn’t so anymore.
Do we still do it that way? How do you prepare yourself for a medically necessary cesarean section? What is the procedure like? How painful is it, and what is recovery like?
1. Dont Believe Anything on the Internet 2. Prenatal Checkups 3. Hospital Safety Protocol 4. Hospital Registration 5. Packing a Hospital Bag 6. C-Section Surgery 7. C-Section Recovery 8. C-Section Incision Care 9. Pain Relief 10. Establishing Milk Supply 11. Hospital Rules & Routine
This is an intersecting account of two cesarean sections performed in early 2021 in the state of California. Out of respect for the patient’s privacy, no names or identifying details are included.
None of this is nor is intended to be medical advice of any kind, but is provided for education only. Always consult your own primary physician, neonatologist, pediatrician, or OB/GYN.
“Do Not Believe Anything You Read on the Internet” – Delivering Doctor
At 33 weeks into the pregnancy, the first patient under discussion experienced hiccups coming from the womb. She looked online to find out if these were a good or bad sign. The search results were alarming, prompting her to contact her doctor by email as was standard for non-emergency communication both pre- and post-pandemic.
Patient No. 1 emails her doctor about “repetitive movements in my belly that seem like hiccups” and occur “at least 3-4 times a day.” She didn’t think this was a problem but had read something online that one should check with their doctor if it happens a lot after 32 weeks.
DOCTOR: “You are correct that hiccups even if it’s too frequent are very normal—do not believe anything you read on the internet.”
Patient had attended an online natural birthing class, read books on natural birthing, and considered her doctor among the best in the area, and had even arranged to switch insurance providers so this doctor could deliver her baby.
Mid the pregnancy, this doctor advised a scheduled cesarean section. A second concurring opinion was obtained from another doctor.
Prenatal Checkups & Doctors Visits
Patient’s doctor operates out of one suit of a medical center adjacent to the area’s hospital. Masks were required at every visit. COVID testing wasn’t required for any prenatal visits at either doctor nor a third specialist doctor. Patient’s spouse was unable to attend the doctor visits and was required to wait in the lobby and/or outside the building. The doctor allowed him to enter for the ultrasound that confirmed fetal heartbeat.
Delivering Hospitals: Testing, Masks & Safety Protocol
Both mothers were required to get a COVID test prior to delivery. Fathers were not initially required to, but to move beyond maternity, one of two hospitals required COVID test results before allowing dad to go elsewhere. That meant a four-hour wait at exactly the wrong time—and you may want to prevent that from occurring, Dad, by getting tested in advance. (The other hospital discussed here didn’t require COVID testing for dad.)
Both mothers and their spouses (and all hospital visitors and staff) wore masks throughout their stay.
While in their rooms in maternity, patients and their spouses could remove their masks, but were required/advised by signage to put them on whenever nurses entered.
Registration was done online or by paper form that one fills out either before or after their arrival, and hands in at maternity upon arriving for delivery. The form is all that is required of the patient as the doctor’s team has cared for the rest.
Packing a Scheduled C Section Hospital Bag
Patient packed two large bags for the hospital. These proved unnecessary. Multiple pairs of clothing went unworn, and most of the hospital bags served no purpose. What was used was the following:
- Phone charging cable (the longest cable she had)
- Snacks. Pack days’ worth for two people.
- A change or two of clothes. The patient wore a surgical/maternity gown for the duration of her stay.
- File folder or laptop bag. Patient was given tremendous amounts of paperwork, none of it unusual. Discharge instructions for mom and her baby were each 48-pages long, and prescriptions, doctor’s notes, temporary birth registration information, insurance information, and more added up quickly.
- Nipple cream. After surgery, a lactation consultant helped the patient establish milk supply. Heating pads, bottles for milk, and the hospital’s breast pump were loaned/provided for free.
- Body soap and shampoo. These were not provided by the hospital.
Cesarean Section Surgery
Patient’s doctor advised no food or liquid (even water) for 8 hours prior to surgery, and scheduled hospital check-in for three hours before the surgery was to occur. One visitor was allowed at the hospital and during the surgery.
Patient was settled into a nearby room, had her vitals taken, was connected to an IV drip, and her pelvic area was shaved. Spouse was in the room with her and later sat at the head of the operating table with the anesthesiologist, all of them wearing masks.
Throughout pregnancy, a mother usually interacts with and sees one medical professional: her own doctor/OBGYN (or a couple of doctors, one at a time, if at a larger practice or network hospital.) Once she is in the hospital, that doctor may still be mom’s most important caretaker, but he or she is far from mom’s only point of contact, nor is she the only person who will be talking to, servicing, comforting, and operating on mom.
Birth is a team activity. Your team includes multiple nurses (two before the surgery, three to five at the surgery, and a new nurse every 12 hours in maternity after one has delivered the baby), an anesthesiologist, a second surgeon, and two or more nurses to attend to the baby, remove the fluid from his/her lungs, and get baby breathing on their own and stable.
A spinal was done prior to surgery. Five to seven minutes into the surgery, a healthy baby was delivered. Sewing up mom took another 15 minutes. Patient felt no pain, only heavy tugging, pressure and movement.
Cesarean Section Recovery
Patient is given a catheter and is mostly bedridden for 3 to 5 days, or fewer if her recovery is more rapid. Abdominal pain is intense and mitigating it is a challenge: the pain medication used does a great job of reducing or eliminating pain, however it also causes constipation.
Surgical staples closed the incision. It’s 6 inches long and as straight as a blade. It should heal to be virtually imperceptible and well hidden by any bikini or underwear. Before discharge from the hospital, a nurse removed the surgical staples and put “Steri strips” (surgical tape) in their place to continue helping hold the incision closed.
Mom’s doctor had previously informed her that, “From personal experience, you will only feel the tactile movement of the staples coming out, but not sharp pain, because we cut the superficial nerves [while] making the incision, so it makes the surrounding skin feel numb.” This tape was removed at the patient’s first postnatal visit to her doctor.
Thick feminine pads are worn along with highly breathable gauze underwear that nurses uniformly called “Victoria Secret underwear.” The hospital provided several pairs of this underwear for use at home.
When that supply was exhausted, the patient ordered these underwear from Amazon, with no low cut line that would rub or affect the healing incision. (These C-section recovery underwear are a workable less costly alternative.)
The jobs of whoever is mom’s sole allowed visitor are many. First and foremost, keep her cheerful and optimistic but do not make her laugh. Mom’s partner, spouse, or sole visitor should keep constant attention on this.
With the build-up of gas in the abdomen, laughing was the second most painful part of the patient’s stay. The most painful was getting into and back out of bed. Take it slowly and don’t hesitate to ask the nurse for help any time you need it.
Twelve nurses attended mom while she was in maternity; one nurse per shift. Nurses are on 12-hour shifts. Ten of them were incredibly personable and willing to do anything asked for by the patient. Do not hesitate to ask for this help.
Patient’s room included a classic dry-erase hospital/maternity board that was updated daily. Its purpose is to present all of the new mother’s and baby’s most basic information to each nurse.
The doctor had informed mom that, “after delivery, the top of the uterus is at the level of the belly button,” and “every time you breastfeed or pump, it releases Pitocin in your brain and causes your uterus to cramp. That crampy pain helps the uterus shrink and cleans out the blood.” One per shift (evening and mid-morning) the nurse on call applied (painful) pressure to the abdomen in a “fundal check” that assesses the progress of this cycle.
Cesarean Section Incision Care
The hospital provided a card with detailed guides on incision care, along with a pocket makeup mirror for the patient to be able to inspect the incision daily. The card read:
“Surgical site infections are painful, costly and may possibly lead to re-admission to the hospital. This may separate you from your baby, and antibiotics may interfere with breastfeeding. The incision site needs to be clean and dry at all times. The surgery site needs to be cleaned and inspected daily. Please follow these simple instructions, and have someone help you if possible.
- “1. WASH YOUR HANDS with soap and wanted before touching the incision area.
- “2. SHOWER EVERY DAY; tub baths are not recommended until the site is completely healed.
- “3. Use a mild soap when showering and allow water to run over the incision site. Do NOT scrub the site.
- “4. Rinse the site well with water.
- “5. Pat incision site dry with a clean washcloth (always use a fresh clean cloth, Do Not use a cloth that has been used to dry other parts of the body).
- “6. Allow the incision to air dry.
- “7. Use the mirror provided to inspect the incision site—Do Not touch the site unless you WASH YOUR HANDS with soap and water first.”
“Is There an Infection?
“It is normal to see small amounts of blood or fluid draining from the site within the first week, especially at the corners. If there is a bad odor from the area, you need to shower and clean the incision as instructed on the front of this card. Increase the cleaning time to 3 times a day.
“Call your doctor first before you go to the emergency room. Especially during the flu season, the emergency rooms are very busy with many sick people. Do not expose yourself and your new baby to this unless it is emergency [sic]. Your doctor is always available by phone through the office, even at night or on the weekends and holidays.
“Your doctor wants to see you in the office instead of the emergency room. Call your doctor if you see any of the following:
- “1. A painful, warm and red area around any part of the surgery site.
- “2. Large amount of fluid or blood coming from the site after you cleaned it.
- “3. Bad odor that persists after a shower and extra cleaning.
- “4. You have a fever greater than 100.4 degrees.
- “5. The pain medicine is not helping the pain after 1-2 hours.”
“It is important to us at Adventist Health — that you know how to care for your surgery site at home, and reduce the risk of a surgical site infection.”
Post Cesarean Section Pain Relief
MEDICATION | Upon admittance to the hospital, nurses asked the patient what her pain tolerance level was, on a 1 to 10 scale, 10 being the worst. This was logged by the nurses along with data and details on potential allergies, and whether the patient consented to a blood transfusion in the event it became necessary. The patient gave her tolerable pain level as a 7. Thereafter, if she wanted medication to reduce her level of pain, the nurse on duty asked how bad the pain was. If she gave a number under 7 (her pre established pain threshold) the nurse would give less or no pain medication. “If you say it’s a 7 I can give you two pills [of Motrin], if [you say] it’s less than a 7, I can only give you one,” a nurse shared.
PASSING GAS | One of the greatest sources of pain following the surgery was the accumulation of gas in the stomach. This grew increasingly uncomfortable, and began to spread to the shoulders, chest and upper body. “Passing gas” is a significant milestone in recovery. Nurses recommended the patient walk around as soon as she possibly could, to aid in passing gas. Because the medications used during and after the cesarean cause constipation, a stool softener was also prescribed.
LIMITING MOTION | Patient got into and out of bed and the shower, and went to the bathroom with the help of nurses. Once able to walk unassisted (roughly 36 hours post), she used only her arm and leg muscles, with the stomach and abdominal muscles doing no work at all in getting into and out of bed, into and out of the shower, and in using the restroom.
Establishing Milk Supply
The day after delivery, a lactation consultant helped mom in getting her milk supply established. Consultant provided single-use heating packs (to be used above clothing to warm the breasts before pumping), trained her in a breast massage to be done after the breasts were warmed, a hospital grade pump, and bottles for milk collection. Consultant advised on a pumping schedule.
Hospital Rules and Routine
The hospital’s visitor policy is displayed at all entrances:
“No visitors in the building!
“No hospital visitors with the following exceptions:
- Hospice — one visitor
- Pediatrics — one visitor
- OB Unit — one visitor
- Neonatal Intensive Care Unit — one visitor”
A placard posted on all patient doors reads:
“1. Never fall asleep with your baby in your arms. Always put the baby in the bassinet before you fall asleep.
“2. Anyone taking your baby out of your room must wear an identification badge with a pink background.
“3. Your baby should not be carried out of the room in your arms. [Baby was fastened into the car seat when taken out of the hospital.]
“4. Never leave your baby alone.
“5. You must have a car seat when taking your baby home.
Hospital parking could be paid for by the hour or day ($1.50 up to 20 mins, $6.50 for a day pass; $25 for a 5-day pass; $1 total with a disabled placard.) Some patient’s spouses in maternity were given complimentary parking passes for the duration of their stay; ask your nurses if the same might apply to you. Parking is unattended on the weekends, and thus is free.
Meals, food, snacks
The hospital provided mom all meals and any requested snacks and sandwiches between meals. Dad didn’t have meals delivered, but could have snacks and sandwiches. The food court / cafeteria in the hospital is closed. Sodas and snacks can be purchased from an on site vending machine.
Coming and Going from the Hospital
One hospital allowed patients (and their spouses/sole visitor) in maternity to come and go during the day between the hours of 8am and 8pm. Patients had to wear their admission bracelets at all times, and go through security at the entrance, where their temperatures were taken daily. The other hospital required that once patients were checked in, they stayed on site. Leaving and then returning wasn’t an option for dad until mom was discharged.
Car Seat Inspection
It is widely thought that hospital staff will physically inspect to confirm that a new parent has a car seat and that it is properly installed. This wasn’t the case at either hospital. Help was available as needed and either parent had to sign that they had a car seat, that it was properly installed, and that they understood related laws. A lead nurse in maternity had the patient bring her car seat into the hospital, so they could run the manufacturer’s number through a recall database. “If it’s a new car seat you shouldn’t have a problem,” the lead nurse told her, “but if there’ve been any recalls, you would have to get a new one before the baby leaves with you to go home.”
Despite the hectic and stressful time for medical professionals, the entire experience was incredibly well handled.
The doctors and all nurses were extremely helpful, caring, and experienced.
Patients felt very well taken care of and were never uncertain or unable to get their questions or concerns addressed.